COL 11(5), 051701(2013) CHINESE OPTICS LETTERS May 10, 2013

Determination of ablation threshold of dental hard tissues

irradiated with Er:YAG and Er,Cr:YSGG lasers
Zhenlin Zhan ( É), Xianzeng Zhang (ÜkO), Wenqing Guo (H©Ÿ), and Shusen Xie (äÜ) ∗

Fujian Provincial Key Laboratory for Photonics Technology, Key Laboratory of OptoElectronic Science and Technology for
Medicine of Ministry of Education, Fujian Normal University, Fuzhou 350007, China
∗
Corresponding author: [email protected]
Received October 29, 2012; accepted January 25, 2013; posted online April 24, 2013

We evaluate the ablation thresholds of Er:YAG and Er,Cr:YSGG laser for enamel and dentin. A total of
140 dental slices is evenly divided into two groups: the dentin group and the enamel group. Dental tissues
are irradiated with either an Er:YAG laser or an Er,Cr:YSGG laser with pulse widths in the order of 100
µs. The laser fluence is increased gradually until the ablation crater is formed. The laser ablation threshold
is calculated using probit analysis. The ablation thresholds of the Er:YAG laser for dentin and enamel
range from 2.88 to 3.36 J/cm2 and from 2.94 to 3.8 J/cm2 , respectively, and the ablation thresholds of
the Er,Cr:YSGG laser for dentin and enamel range from 2.92 to 4.2 J/cm2 and from 4.93 to 5.66 J/cm2 ,
respectively.
OCIS codes: 170.1020, 140.3500, 170.1850.
doi: 10.3788/COL201311.051701.

Er lasers are considered the most promising alternatives the pulse duration is shorter.
to traditional mechanical instruments for the preparation Several methods, for instance, probability statis-
of various tooth structures[1,2] . The primary ablation tics of the occurrence of ablation[9,10], theoreti-
mechanism of Er-based lasers is the thermomechanical cal calculations[6] , the optoacoustic measurement
process. Laser energy absorbed by water can heat in- approach[11,12], and curve fitting[13−15] in which the in-
terstitial water and raise internal pressures to reach the tersection of the extrapolated ablation rate curve and
ultimate tensile strength of hard tissue. These phenom- horizontal axis is taken as the threshold, have been
ena result in the removal of the outer layers of dental adopted to determine the ablation threshold. However,
tissues without thermal and mechanical damage to the a global ablation model has yet to be established be-
surrounding tissues or tooth pulp[3−5] . The application cause of the complex nature of the interactions between
of laser ablation in dentistry has attracted increasing lasers and dental hard tissues. Moreover, considering the
attention because of its unique advantages, such as non- diverse characteristics of biological tissues, the determi-
contact modality, reduced pain, and accurate removal of nation of ablation thresholds is difficult because it can
damaged tissue. be affected by a number of factors. To date, probability
Selecting appropriate laser parameters suitable for a statistics is believed to yield threshold values closest to
given dental condition is important. One of the funda- the actual value[9] .
mental issues in laser ablation is the determination of This letter evaluates the ablation thresholds of Er:YAG
the ablation threshold of different laser wavelengths in and Er,Cr:YSGG lasers for dental enamel and dentin.
dental hard tissues. For example, when removal of caries, 53 second molars with completed root growth were
enamel, or dentin is desired, the laser energy must be collected from 46 healthy subjects (18–30 years old, 34
higher than the ablation threshold. However, for caries males, 12 females). The molars were removed by ex-
prevention, chemical or structural changes, rather than traction or osteotomy for medical reasons. The use of
ablation, are desired, and the laser energy must be lower human molars in this letter was approved by the Ethics
than the ablation threshold. Knowledge of the ablation Committee of Fujian Normal University. The remaining
thresholds of dental hard tissues constitutes the basis for soft tissue on the extracted teeth was removed and the
laser use in dentistry. teeth were thoroughly rinsed in tap water. The teeth
Several studies have attempted to evaluate the ablation were cut into 2 or 3 slices (∼ 1 mm thickness) along the
thresholds of Er lasers since they are first introduced to longitudinal direction using a diamond wheel saw (Model
the medical field in the late 1980s. In 1989, an early 650, South Bay Technology Inc., USA). A total of 140
investigation demonstrated that Er:YAG lasers were ca- slices was obtained and stored in physiological saline at
pable of effectively ablating dentin and enamel tissues[6] . 4 ◦ C before use. The treated parts focused on the oc-
In addition, the ablation threshold values of dentin and clusal and central region of the slices near the center of
enamel were calculated based on a simple model. A pre- the tooth. The exposed surface of the hard tissue slice
liminary comparative study of the 3-µm laser actions of was ground by a water-cooled polishing machine using
Er-doped YAG, YSGG, YAP, and YLF lasers on dental a series of silicon carbide sandpapers of 240–1200 grit
hard tissues has also been performed[7] . Apel et al.[8] followed by ultrasonic cleaning. Dental samples were
found that the ablation threshold of Er:YAG lasers could evenly and randomly divided into enamel and dentin
be influenced by the pulse duration and radiant expo- groups and each group was evenly and randomly divided
sure. In this study, a shift to lower radiant exposure at into two irradiation groups: the Er:YAG group and the
the lower limit for the onset of ablation is observed when Er,Cr:YSGG group. The irradiated area focused on the

1671-7694/2013/051701(5) 051701-1 c 2013 Chinese Optics Letters

COL 11(5), 051701(2013) CHINESE OPTICS LETTERS May 10, 2013

middle enamel and dentin. based on stereomicroscope examinations and SEM. An

Er:YAG laser beams (Contour Profile 2940, Sciton, ablation threshold is observed for both dentin and enamel
USA) were transmitted through an articulated-mirror- tissue. Below this threshold, no tissue removal is dis-
arm system and focused on the sample surface through a cernable, as demonstrated by the laser fluence escalation
lens. The radiant exposure delivered to the dental sample experiment. Figure 4 shows the probability of the oc-
was monitored by an energy meter (NOVA II, Orphir, currence of ablation in the enamel and dentin tissue
Israel) coupled to a pyroelectric detector (Fig. 1(a)). as a function of the energy density of the Er:YAG and
Er,Cr:YSGG laser beams (WaterlaseTM , BioLase Tech- Er,Cr:YSGG lasers. Probit analysis indicates that the
nology, USA) were transmitted through an optic fiber thresholds of the Er:YAG laser for dentin and enamel are
system to a handpiece consisting of a sapphire tip (Fig. 3.08 and 3.27 J/cm2 , respectively (Figs. 4(a) and (b)).
1(b)). Laser energy was measured before and after each
experiment. When the measured energy had decreased
by over 15% of the initial energy during the experiment,
the tip was replaced. In addition, a built-in pressurized
water spray system with adjustable flow rate was incor-
porated into the handpiece. Based on pre-experimental
results, the air pressure and water level were set to 60%
and 70%, respectively. The laser irradiation parameters
are listed in Table 1. Laser fluence was gradually in-
creased until an ablation crater was generated.
After laser irradiation, tooth samples were examined
and imaged under a stereomicroscope (MZ16FA, LEICA,
Germany). Detailed structural changes in the irradiated
areas were further examined by a scanning electron mi-
croscope (SEM, JSM-6380LV, JEOL, Japan). The im-
ages were then examined by a dentist and a physicist to
determine the occurrence of ablation. The appearance
of a crater or the removal of hard tissue was used as a
criterion of laser ablation. The ablation was scored as 1
(tissue removal) or 0 (no tissue removal)[9].
The probability of the occurrence of ablation for
different tissue types and lasers was calculated by probit Fig. 1. Illustration of the experimental setup. (a) Er:YAG
analysis[9] . The threshold irradiation exposure was de- laser and (b) Er,Cr:YSGG laser.
termined as the laser dose under which ablation occured
in 80% of the specimens. The 95% confidence interval
of the threshold irradiation exposure was defined as the
threshold range.
Although the superficial layer of the dental samples
can be ablated by Er:YAG and Er,Cr:YSGG lasers once
a certain laser energy is achieved, more dentin tissue is
removed compared with enamel tissue under the same
laser fluence (Fig. 2). As expected, ablation occurs more
markedly at the center of the beam compared with the
edge of the crater at the microscopic level and results
in a corrugated profile (Fig. 3). Dentin samples exhibit
several open dentinal tubules with remaining debris after
Er:YAG laser irradiation (Fig. 3(a)). By contrast, the
dentin surface is cleaner after Er,Cr:YSGG laser irradia-
tion and more open dentinal tubules and less debris are Fig. 2. Tissue ablation by different lasers as observed under
observed (Fig. 3(c)). a stereomicroscope. (a) Dentin and (b) enamel tissues irra-
Whether or not and to what extent the ablation of diated by the Er:YAG laser at 3.86 J/cm2 . (c) Dentin and
dental hard tissue occurs were quantitatively determined (d) enamel tissues irradiated by the Er,Cr:YSGG laser at 5.09
J/cm2 .
Table 1. Parameters of Laser Irradiation
Energy Density (J/cm2 )
Lasers Pulse Width (µs) Spot Size (mm) Pulse Rate (Hz) Work Distance (mm) Time (s)
Enamel Dentin
Er:YAG ∼ 200 1 1 25 1 1.43–4.78 1.43–4.78
140 0.74 20 1 5 1.14–5.82 1.14–5.09
Er,Cr:YSGG
140 0.89 20 1 5 0.93–4.83 0.93–3.94

051701-2
COL 11(5), 051701(2013) CHINESE OPTICS LETTERS May 10, 2013

but much lower than that in Ref. [10] (13 J/cm2 ).

Based on a comparison between the ablation thresh-
olds established by each research group, a noticeable
discrepancy may be observed. This discrepancy may be
attributed to several factors. Firstly, tissue characteris-
tics, including optical, thermodynamic, and mechanical
properties, vary among different types of tissues. The
dental samples used among published studies vary. For
instance, Apel et al.[10] used wisdom teeth as targets
whereas Kang et al.[9] used adult human molars. Even
when the same type of dental tissue is used, the composi-
tion of dental tissues may show regional differences, and
these difference can affect the ablation threshold. The
difference in laser ablation was validated with the cervi-
cal and buccal or oral regions of the enamel[10] . Secondly,
Fig. 3. Tissue ablation by different lasers as observed un- Ablation thresholds may further be affected by various
der SEM. (a) Dentin and (b) enamel tissues irradiated by laser parameters, such as the wavelength, repetition rate,
the Er:YAG laser at 3.86 J/cm2 . (c) Dentin and (d) enamel and pulse duration. For example, the pulse width of the
tissues irradiated by the Er,Cr:YSGG laser at 5.09 J/cm2 .
Er,Cr:YSGG laser used in this letter is 140 µs, similar
to those used in Refs. [9,10]. By contrast, Belikov et
al.[7] used a pulse width of 400 µs. The influence of
the pulse duration of the Er:YAG laser system on the
ablation threshold for dental enamel was discussed by
Apel et al.[10] . The threshold shift induced by different
pulse widths in the range from 100 to 700 µs is of one
order of magnitude of the fluctuation resulted from local
differences in the composition of dental tissue samples.
Moreover, a shift may be observed in the lower limit
of onset of ablation when the pulse duration is shorter.
The thermal loss mechanism is a function of time; thus,
larger amounts of energy diffuse into the surrounding
tissue with longer pulse widths. Lower ablation thresh-
olds are observed when shorter pulse durations are used.
Additional factors arise from the method used to de-
termine the ablation threshold. The principles and
equipment used in each determination method vary.
Considering the inhomogeneity of biological tissues, the
Fig. 4. Probability of the occurrence of dental tissue ablation thresholds determined by probability statistics are be-
by Er:YAG and Er,Cr:YSGG lasers. lieved to closely approximate actual values. However,
the definition may differ even in this method. Apel et
The thresholds of the Er,Cr:YSGG laser for dentin and al.[10] determined thresholds based on a probability of
enamel are 3.35 and 5.20 J/cm2 , respectively (Figs. 4(c) 80%, whereas Kang et al.[9] employed a probability of
and (d)). only 50%. Furthermore, differences in the determina-
The ablation threshold ranges of the Er:YAG and tion criteria for the occurrence of ablation may have an
Er,Cr:YSGG lasers for enamel and dentin are shown important function in the thresholds obtained. Kang
in Fig. 5. The ablation thresholds of the Er:YAG laser et al.[9] defined the ablation threshold as the incident
for dentin and enamel range from 2.88 to 3.36 J/cm2 radiant exposure that induced either mass ejection or
and from 2.94 to 3.8 J/cm2 , respectively. The abla- surface disruption. In this letter, tissue removal is taken
tion thresholds of the Er,Cr:YSGG laser for dentin and as the exclusive standard of ablation occurrence; tissue
enamel range from 2.92 to 4.2 J/cm2 and from 4.93 to
5.66 J/cm2 for dentin and enamel, respectively.
A crucial issue in laser applications in dentistry is the
evaluation of ablation thresholds using different laser
wavelengths. In this letter, the Er:YAG and Er,Cr:YSGG
laser thresholds for enamel and dentin were system-
atically evaluated. Table 2 summarizes the ablation
thresholds of dental hard tissues published in different
reports. Regardless of the type of tissue used, dentin
or enamel, the threshold values for the Er:YAG laser
obtained in this letter are slightly lower than those in
previous studies[6,7,10,14,16] . The ablation threshold of
enamel for the Er,Cr:YSGG laser is 5.20 J/cm2 , higher Fig. 5. Ablation threshold ranges for dental tissue irradiated
than those in Refs. [7,9] (4 and 2.1 J/cm2 , respectively) by the Er:YAG and Er,Cr:YSGG lasers.

051701-3
COL 11(5), 051701(2013) CHINESE OPTICS LETTERS May 10, 2013

Table 2. Ablation Thresholds of Dental Hard Tissues Published in Dif ferent Reports

Laser Tissue Reference Threshold J/cm2 Method / Pulse Width

[10]
Enamel Apel 10 (9–11) Probability Statistics (80%), 150 µs
[6]
Enamel Hibst 10 Theoretical Calculation
Enamel Fried[16] 7–9 Experimental Estimates, 150 µs
Er:YAG Enamel Belikov[7] 7 Experimental Estimates, 400 ms
Enamel Present Work 3.27 (2.94–3.8) Probability Statistics (80%), ∼ 200 µs
Dentin Farrar[14] 5.2 Curve Fitting
[6]
Dentin Hibst 10 Theoretical Calculation
Dentin Present Work 3.08 (2.88–3.36) Probability Statistics (80%), ∼ 200 µs
Enamel Apel[10] 13 (10–14) Probability Statistics (80%), 150 µs
[9]
Enamel Kang 1.2/2.1 Probability Statistics (50%), 100 µs
Er,Cr:YSGG [7]
Enamel Belikov 4 Experimental Estimates, 400 ms
Enamel Present Work 5.2 (4.93–5.66) Probability Statistics (80%), 140 µs
Dentin Present Work 3.35 (2.9–4.2) Probability Statistics (80%), 140 µs

degeneration is not regarded as a sign of ablation. As µm (480 cm−1 )[17] . Moreover, the wavelengths of the
such, the thresholds determined in this letter are higher Er:YAG and Er,Cr:YSGG lasers correspond to free wa-
than those in Ref. [9]. ter and OH− groups within the mineral molecule, respec-
Due to the complex nature of dental tissue, the ablation tively. The near-instantaneous vaporization of free water
threshold cannot be determined as an exact value and is at 2 940 nm and the transfer of conductive heat from ap-
instead presented as a range. In this context, a sensitivity atite to free water at 2 780 nm may contribute to the
of 80% during statistical analysis is adopted in this study. different thresholds of the two lasers. A water spray was
Such a sensitivity indicates that ablation may take place provided during Er,Cr:YSGG laser irradiation. External
in a specific portion of a sample when irradiated with an water absorbs laser energy and consequently induces a
energy density lower than the ablation threshold. The higher ablation threshold. However, a water film of cer-
appearance of ablation at doses lower than the threshold tain thickness promotes the effectiveness of ablation[18] .
may be clearly observed in some specimens by SEM. The role of external water in ablation must be clarified
The ablation thresholds of both lasers in enamel are in further studies.
higher than those in dentin, as shown in Fig. 4. The In conclusion, the ablation thresholds of Er:YAG and
results closely correlate with the composition and ab- Er,Cr:YSGG laser radiation for dental enamel and dentin
sorption properties of the dental materials investigated. are systematically evaluated using probability statistics.
While enamel and dentin are composed of the same Under the tested conditions, the ablation thresholds of
materials, the proportions of these materials vary sig- the Er:YAG laser for dentin and enamel are determined
nificantly between the samples. Enamel contains, by vol- to range from 2.88 to 3.36 J/cm2 and from 2.94 to 3.8
ume, 12% water, 3% proteins and lipids, and 85% miner- J/cm2 , respectively. The ablation thresholds of the
als composed mainly of hydroxyapatite. Dentin is com- Er,Cr:YSGG laser for dentin and enamel are slightly
posed of 20% water, 33% proteins and lipids, and 47% higher and range from 2.92 to 4.2 J/cm2 and from 4.93
minerals[17] . The water component in the tissues strongly to 5.66 J/cm2 , respectively. These findings suggest that
absorbs laser energy and induces micro-explosions that the ablation threshold range of enamel is higher than that
blast away minuscule particles of hard tissues because of of dentin and that the threshold of the Er:YAG laser is
the considerable overlap between the wavelength of the lower than that of the Er,Cr:YSGG laser. The ablation
Er lasers and the water absorption band. The water con- thresholds vary with the type of dental tissue and the
tent in dentin is almost twice that in enamel. Therefore, type of laser used.
more laser energy is necessary to remove enamel while
less energy is necessary to remove dentin. Differences in This work was supported by the National Natural Sci-
the ablation thresholds of enamel and dentin may also be ence Foundation of China (No. 60878062), the Science
due to variations in the structures of the samples. Denti- Research Foundation of Ministry of Health & United
nal tubules are arranged in an orderly manner, and the Fujian Provincial Health and Education Project for
structure of dentinal tubules contributes to their poros- Tackling the Key Research (No. WKJ2008-2-035), and
ity. the Natural Science Foundation of Fujian Province (No.
Compared with the Er,Cr:YSGG laser, the thresholds 2012J01255).
of the Er:YAG laser for enamel and dentin for are lower.
This difference may be attributed to variations in the References
absorption coefficients and dynamics at the individual 1. P. Ekworapoj, S. K. Sidhu, and J. F. Mccabe, Lasers
wavelengths of the lasers. The absorption coefficient µa Med. Sci. 22, 175 (2007).
of enamel at 2.94 µm is 800 cm−1 , twice that at 2.78 2. S. Parker, Br. Dent. J. 202, 445 (2007).

051701-4
COL 11(5), 051701(2013) CHINESE OPTICS LETTERS May 10, 2013

3. J. Meister, R. Franzen, K. Forner, H. Grebe, S. Stanzel, 11. P. Rechmann, T. Hennig, U. von den Hoff, and R. Kauf-
F. Lampert, and C. Apel, J. Biomed. Opt. 11, 034030 mann, Proc. SPIE 1880, 235 (1993).
(2006). 12. T. Hennig, P. Rechmann, C. G. Pilgrim, H. Schwarz-
4. W. Raucci-Neto, M. A. Chinelatti, and R. G. Palma- maier, and R. Kaufmann, Proc. SPIE 1424, 99 (1991).
Dibb, Photomed. Laser Surg. 26, 523 (2008). 13. B. Majaron, M. Lukac, D. Sustercic, N. Funduk, and U.
5. X. Z. Zhang, X. Y. Wang, Z. L. Zhan, Q. Ye, and S. S. Skaleric, Proc. SPIE 2922, 233 (1996).
Xie, Chin. Opt. Lett. 7, 830 (2009). 14. S. R. Farrar, D. C. Attril, M. R. Dickinson, T. A. King,
6. R. Hibst and U. Keller, Lasers Surg. Med. 9, 338 (1989). and A. S. Blinkhorn, Appl. Opt. 36, 5641 (1997).
7. A. V. Belikov, A. V. Erofeev, V. V. Shumilin, and A. M. 15. X. Z. Zhang, S. S. Xie, Q. Ye, and Z. L. Zhan, Chin.
Tkachuk, Proc. SPIE 2080, 60 (1993). Opt. Lett. 5, 235 (2007).
8. C. Apel, R. Franzen, J. Meister, H. Sarrafzadegan, S. 16. D. Fried, J. D. B. Featherstone, S. R. Visuri, W. D. Seka,
Thelen, and N. Gutknecht, Lasers Med. Sci. 17, 253 and J. J. T. Walsh, Proc. SPIE 2672, 73 (1996).
(2002). 17. J. D. B. Featherstone and D. Fried, Med. Laser Appl.
9. H. W. Kang, I. Rizoiu, and A. J. Welch, Phys. Med. 16, 181 (2001).
Biol. 52, 7243 (2007). 18. X. Zhang, Z. Zhan, H. Liu, H. Zhao, S. Xie, and Q. Ye,
10. C. Apel, J. Meister, R. S. Ioana, R. Franzen, P. Hering, J. Biomed. Opt. 17, 38003 (2012).
and N. Gutknecht, Lasers Med. Sci. 17, 246 (2002).

051701-5